Tuesday, April 22, 2008

GOVERNMENT needs to put the brakes on plans on massively boost nursing numbers until they solve the worst shortage in hospital training places the profession has seen, John Daly, Chair of the Council of Deans of Nursing and Midwifery (Australia and New Zealand), said.

Professor Daly, speaking on the sidelines of the 2020 Summit in Canberra, said in some states such as New South Wales, nursing undergraduates were already unable to do the hours of practical clinical training in hospitals required to complete their courses."This is the worst we’ve seen it, and it’s not just in NSW. The Deans of Nursing and Midwifery are saying it’s a problem across the country," he said.

The Rudd Government’s health policy relies heavily on its promise to ramp up the number of nurses and other health workers, announcing last month it would train up to 50,000 new frontline health professionals.

But Professor Daly said governments had to address existing bottlenecks in supervised clinical hours in hospitals, and expand training opportunities for undergraduates in GP practices and community health, if it was not to exacerbate the crisis.

"Let’s be very cautious before we rush to increase them any further before we resolve this clinical training problem," he said.

Secondly, student nurses could get plenty of clinical training on-the-job if they returned to working junior nursing positions, but that sort of makes universities redundant - what would you do with all the clinical educators and nursing preceptors?

Sunday, April 20, 2008

Paging Dr has had some discussion on fashion amongst medical students and junior doctors. In Australia, we don't generally have the advantage of covering everything with a white lab coat. I'm no fashionista, and I recognise that there is a great deal of variety in how people choose to dress.From a practical standpoint, These are my tips for fashion in the clinical environment:

Wear something easy to change. Especially if you are going to enter theatre, you don't want to have to spend forever getting changed.

Wear something stain resistant. Blood, pus and goo are regular staples on the wards. You want something that you can wash, or dry-clean without breaking your budget.

Wear something comfortable, or which will become comfortable. You will be working long days, and do not want to have to keep taking things on and off all the time. This is especially true for footwear. Not many of us have a luxury of an office or a locker. Having said that, if you get one, hold onto it for dear life.

Avoid short skirts or low necklines. Unlike TV shows, hospitals are not a pick-up venue. You are here for work or study, and there are no janitor's closets for you to have a quickie in. Apart from what your colleagues might or might not think, you also have patients to think about. One of my interns once complained that she could not insert any male IDCs, because they would always have an erection when she came to do it. I had to explain that showing your cleavage every time you bend over might not be helping. Also remember that geriatric wards are often full of disinhibited old men. Nurses learn very quickly not to lean over in short skirts. You should too.

Do not dress more formally than your registrar or consultant. Especially if you are mature-age, you do not want patients to think you are the boss. It is embarassing for you, the consultant, and the patient. On the other hand, if your consultant likes to prance around in leather jackets or looks like a frumpy old housewife, then anything goes.

Avoid jewellery. Bling does not make you look more professional. Bling makes it difficult to wash your hands or to wear gloves. Bling has lots of crevices where blood is hard to clean out. Bling has a tendency to disappear.

Don't worry if you can't remember the rules. Sooner or later you will work them out, but there might be a few unpleasant experiences along the way.

Friday, April 18, 2008

As every new inbound link is precious to me (mainly because I don't have that many) I have agreed to host one of these Blog Carnival thingies in the next few weeks. This is somewhat of a problem since I tend to just write what I think, and don't go around reading other people's blogs all the time unless there is something specific that catches my eye. Does that make me a hypocrite?

In any case, I suppose the fact that I am hosting a Blog Carnival means I am obliged to start promoting it. And I will have to read all these submissions.

Sunday, April 13, 2008

My experience is that about one in 20 examination gloves (not to be confused with surgical gloves) have a fault of some sort - breaking while being put on, unexpected size discrepancy, holes present already in the glove, deformed glove or adherent to another glove.

I must admit, however, that I am not a big glove wearer. Cringe if you will, but I do not wear gloves to examine groins, scrota, or feet. I only go to the trouble of donning them if there is an ulcer, wound, pus, or (potential) intertrigo (commonly known as skin-fold porridge). I am, however, an avid hand washer and user of alcoholic hand rubs.

I also do not wear gloves when putting in IVs or taking blood. A poorly fitting examination glove is completely useless to me as protection against a needlestick injury. If non-sterile surgical gloves were cheaply available I'd consider wearing them - but poor quality examination gloves only make my job more difficult and dangerous.

MEDICAL examination gloves fail Australian standards in up to three-quarters of cases, either by having holes or by breaking, when stretched, more easily than they should.

Australia's medical standards regulator is investigating after a survey of 24 brands of medical examination gloves -- loose-fitting, ambidextrous gloves commonly donned by health workers where blood or other fluids are present, to protect themselves and their patients from cross-infection -- has found 75 per cent fail required standards.

Of the 24 products, six failed on leaks, 14 broke too easily when stretched, and two were too thin. One brand of gloves was found to have holes in 34 out of the 40 individual gloves tested.

The testing was done by Enersol, an Australian medical device testing company that does a lot of work for international clients such as the UN.

The company this week described the findings as "extremely disappointing", as they suggested that health workers and patients alike were not getting appropriate protection from infection.

Enersol managing director John Gerofi said the results also raised a question-mark over the effectiveness of the regulatory processes used by the Therapeutic Goods Administration.

A spokeswoman for the TGA said the results were not dissimilar to its own findings.

"Doctor Gerofi from Enersol advised the TGA on 18 September that several companies' gloves failed to meet the 'elongation at break' requirements and the water leakage requirements of the Australian and ISO standards," she said. "The TGA is investigating these allegations."

Gerofi told Weekend Health he "became concerned about the rate of holes in gloves as a result of some tests we did for inter-laboratory comparison purposes".

"As a result, we decided to conduct a more formal survey of the Australian market to see whether the available products were complying with accepted standards.

"The results show clearly that many of the examination glove brands on the Australian market do not meet the TGA requirements or the Australian or ISO standards.

"Health professionals using these products, and their clients, rightly expect that the products will meet accepted standards. Regrettably, many suppliers in the industry are not meeting these expectations and the Government's regulatory processes are apparently not detecting the faulty products."

Gerofi said that many of the holes would not be noticeable on a casual inspection, and even occasional breakages would be "shrugged off".

"It is only if there is a whole series of breakages that anyone will lodge a complaint," he said. For the test, which assessed the brands against the relevant Australian standard AS/NZS 4011, gloves were filled with water and holes detected by any leaks.

For the tensile test, a sample of glove was cut out and measurements were taken for both how far it could be stretched before breaking, and the force required to break it.

While gloves with such holes were better for the purposes of infection control than no glove at all, the presence of even small holes meant infectious agents -- bacteria or even superbugs such as MRSA, or viruses such as HIV -- could pass through.

A spokeswoman for the TGA said the agency's regulatory processes comprised a combination of pre-market assessment, post-market monitoring and post-market vigilance programs.

"As part of its post-market monitoring program, the TGA routinely tests examination gloves for compliance with the relevant Australian and International (ISO) standards," she said.

"Over the past 20 months, 34 different samples (drawn from different batches of gloves and a range of manufacturers) have been routinely tested.

Of these 20, nine were from one manufacturer in Asia but supplied by different suppliers in Australia.

Some of the sample failures were due to labelling and other minor issues, rather than being safety related. When glove samples fail, the manufacturer is required to correct the problem or recall the product depending on the type of problem.

The spokeswoman said gloves found to contain holes were "always recalled".

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